|
DRESSING AQUACEL 2x2
|
Facility
|
OP
|
$26.24
|
|
| Hospital Charge Code |
270677555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna Commercial |
$9.97
|
| Rate for Payer: Aetna Medicare Advantage |
$7.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$6.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$6.69
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$6.69
|
| Rate for Payer: Cigna Commercial |
$13.12
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$7.87
|
| Rate for Payer: Oxford Commercial |
$5.25
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.25
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.63
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.70
|
|
|
DRESSING AQUACEL 2x2
|
Facility
|
IP
|
$26.24
|
|
| Hospital Charge Code |
270677555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$3.94
|
|
|
DRESSING AQUACEL 4x4 177902
|
Facility
|
IP
|
$18.69
|
|
| Hospital Charge Code |
270350285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.80
|
|
|
DRESSING AQUACEL 4x4 177902
|
Facility
|
OP
|
$18.69
|
|
| Hospital Charge Code |
270350285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$9.35 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare Advantage |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$4.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$4.77
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$4.77
|
| Rate for Payer: Cigna Commercial |
$9.35
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$5.61
|
| Rate for Payer: Oxford Commercial |
$3.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$2.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$3.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$0.45
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$0.50
|
|
|
DRESSING AQUACEL 4X4.7
|
Facility
|
IP
|
$50.54
|
|
| Hospital Charge Code |
270649157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.58
|
|
|
DRESSING AQUACEL 4X4.7
|
Facility
|
OP
|
$50.54
|
|
| Hospital Charge Code |
270649157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$25.27 |
| Rate for Payer: Aetna Commercial |
$19.21
|
| Rate for Payer: Aetna Medicare Advantage |
$15.16
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$12.89
|
| Rate for Payer: Cigna Commercial |
$25.27
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$15.16
|
| Rate for Payer: Oxford Commercial |
$10.11
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$7.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$10.11
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.22
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.34
|
|
|
DRESSING AQUACEL AG 1/2x18IN
|
Facility
|
IP
|
$57.73
|
|
| Hospital Charge Code |
270649155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.66
|
|
|
DRESSING AQUACEL AG 1/2x18IN
|
Facility
|
OP
|
$57.73
|
|
| Hospital Charge Code |
270649155
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare Advantage |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.72
|
| Rate for Payer: Cigna Commercial |
$28.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.32
|
| Rate for Payer: Oxford Commercial |
$11.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.53
|
|
|
DRESSING AQUACEL AG 3/4x18
|
Facility
|
IP
|
$57.73
|
|
| Hospital Charge Code |
270638207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.66
|
|
|
DRESSING AQUACEL AG 3/4x18
|
Facility
|
OP
|
$57.73
|
|
| Hospital Charge Code |
270638207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Aetna Commercial |
$21.94
|
| Rate for Payer: Aetna Medicare Advantage |
$17.32
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$14.72
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$14.72
|
| Rate for Payer: Cigna Commercial |
$28.86
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$17.32
|
| Rate for Payer: Oxford Commercial |
$11.55
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$8.66
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.55
|
| Rate for Payer: UnitedHealthcare Community & State |
$1.39
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$1.53
|
|
|
DRESSING AQUACEL AG 3.5x12IN
|
Facility
|
IP
|
$171.99
|
|
| Hospital Charge Code |
270654311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
|
|
DRESSING AQUACEL AG 3.5x12IN
|
Facility
|
OP
|
$171.99
|
|
| Hospital Charge Code |
270654311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$65.36
|
| Rate for Payer: Aetna Medicare Advantage |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.86
|
| Rate for Payer: Cigna Commercial |
$86.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.60
|
| Rate for Payer: Oxford Commercial |
$34.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.56
|
|
|
DRESSING AQUACEL AG 3.5x13.75
|
Facility
|
OP
|
$171.99
|
|
| Hospital Charge Code |
270677592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna Commercial |
$65.36
|
| Rate for Payer: Aetna Medicare Advantage |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$43.86
|
| Rate for Payer: Cigna Commercial |
$86.00
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$51.60
|
| Rate for Payer: Oxford Commercial |
$34.40
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.40
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.14
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.56
|
|
|
DRESSING AQUACEL AG 3.5x13.75
|
Facility
|
IP
|
$171.99
|
|
| Hospital Charge Code |
270677592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.80
|
|
|
DRESSING AQUACEL AG 3.5x9.75
|
Facility
|
IP
|
$154.36
|
|
| Hospital Charge Code |
270660553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.15 |
| Max. Negotiated Rate |
$23.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.15
|
|
|
DRESSING AQUACEL AG 3.5x9.75
|
Facility
|
OP
|
$154.36
|
|
| Hospital Charge Code |
270660553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$77.18 |
| Rate for Payer: Aetna Commercial |
$58.66
|
| Rate for Payer: Aetna Medicare Advantage |
$46.31
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$39.36
|
| Rate for Payer: Cigna Commercial |
$77.18
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$46.31
|
| Rate for Payer: Oxford Commercial |
$30.87
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$23.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.87
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.72
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.09
|
|
|
DRESSING AQUACEL AG 3.5x9.75
|
Facility
|
IP
|
$167.65
|
|
| Hospital Charge Code |
270653001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.15 |
| Max. Negotiated Rate |
$25.15 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.15
|
|
|
DRESSING AQUACEL AG 3.5x9.75
|
Facility
|
OP
|
$167.65
|
|
| Hospital Charge Code |
270653001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$83.83 |
| Rate for Payer: Aetna Commercial |
$63.71
|
| Rate for Payer: Aetna Medicare Advantage |
$50.30
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.75
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.75
|
| Rate for Payer: Cigna Commercial |
$83.83
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.30
|
| Rate for Payer: Oxford Commercial |
$33.53
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.53
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.04
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.44
|
|
|
DRESSING AQUACEL AG 6x6
|
Facility
|
OP
|
$113.70
|
|
| Hospital Charge Code |
270649722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$56.85 |
| Rate for Payer: Aetna Commercial |
$43.21
|
| Rate for Payer: Aetna Medicare Advantage |
$34.11
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$28.99
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$28.99
|
| Rate for Payer: Cigna Commercial |
$56.85
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$34.11
|
| Rate for Payer: Oxford Commercial |
$22.74
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.05
|
| Rate for Payer: UnitedHealthcare Commercial |
$22.74
|
| Rate for Payer: UnitedHealthcare Community & State |
$2.74
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.01
|
|
|
DRESSING AQUACEL AG 6x6
|
Facility
|
IP
|
$113.70
|
|
| Hospital Charge Code |
270649722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$17.05
|
|
|
DRESSING AQUACEL AG 6X6 403710
|
Facility
|
OP
|
$168.10
|
|
| Hospital Charge Code |
270632870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$84.05 |
| Rate for Payer: Aetna Commercial |
$63.88
|
| Rate for Payer: Aetna Medicare Advantage |
$50.43
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$42.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$42.87
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$42.87
|
| Rate for Payer: Cigna Commercial |
$84.05
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$50.43
|
| Rate for Payer: Oxford Commercial |
$33.62
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.21
|
| Rate for Payer: UnitedHealthcare Commercial |
$33.62
|
| Rate for Payer: UnitedHealthcare Community & State |
$4.05
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$4.45
|
|
|
DRESSING AQUACEL AG 6X6 403710
|
Facility
|
IP
|
$168.10
|
|
| Hospital Charge Code |
270632870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$25.21 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$25.21
|
|
|
DRESSING AQUACEL AG 8x12 HYDR
|
Facility
|
IP
|
$149.61
|
|
| Hospital Charge Code |
270643952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$22.44 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.44
|
|
|
DRESSING AQUACEL AG 8x12 HYDR
|
Facility
|
OP
|
$149.61
|
|
| Hospital Charge Code |
270643952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$74.81 |
| Rate for Payer: Aetna Commercial |
$56.85
|
| Rate for Payer: Aetna Medicare Advantage |
$44.88
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care |
$38.15
|
| Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO |
$38.15
|
| Rate for Payer: Cigna Commercial |
$74.81
|
| Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC |
$44.88
|
| Rate for Payer: Oxford Commercial |
$29.92
|
| Rate for Payer: Qualcare PPO/HMO/WC |
$22.44
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.92
|
| Rate for Payer: UnitedHealthcare Community & State |
$3.61
|
| Rate for Payer: Wellpoint Medicaid Managed Care |
$3.96
|
|
|
DRESSING AQUACEL AG 9x15cm
|
Facility
|
IP
|
$123.48
|
|
| Hospital Charge Code |
270666440
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Qualcare PPO/HMO/WC |
$18.52
|
|